Prescribing Basics- Quiz 1

Question 1

Identify causes of preventable medication errors that occur during the medication use process.

Answer 1

-1 out of 20 prescriptions filled at the pharmacy has a mistake
-E-prescribing is NOT error free!
-Wrong drug, wrong dose, drug interactions
-Omissions and illegibility
-Directions—do not use error prone abbreviations

Question 2

Develop a plan to incorporate medication error prevention strategies into your clinical practice.

Answer 2

-10 Habits to adopt:
1. Obtain, record and update at every visit the patient’s drug allergies
2. Keep every patient’s medication list up-to-date and in a consistent place
in the medical record.
3. Include in the medication record all prescriptions written (name, dose,
number, refills), samples dispensed, date written, diagnosis for which
medication written, and special instructions given
4. Include in each entry the name of the medication, dose, number
dispensed, and instructions when recording medications ordered and
refilled in the progress notes.
5. At each visit, ask the patient what medications he/she is taking. Ask the patient to include OTC, prescription,
and herbal remedies. An even better habit is to ask patients to bring all
medication bottles at each visit.
6. When ordering a new medication, inform the patient about potential side effects and document that the patient has been so advised.
7. Open a pharmaceutical reference book or log on to Epocrates.com and
read the patient the contraindications, drug interactions, pregnancy precautions, and possible side effects.
8. Provide printed patient medication information forms that list indication,
dosing, potential side effects, and drug interactions for often-prescribed
medications.
9. Rule out pregnancy before prescribing certain medication to
females capable of becoming pregnant.
10. If a patient exhibits “nonadherence” to a treatment plan for chronic non-cancer pain or is not improving on the current
treatment, or if the practitioner suspects that the patient is
abusing or diverting medication, refer the patient to a pain specialist for consultation or evaluation. Don’t
keep prescribing opioids without evidence that they’re working!

Question 3

Describe available resources a health care professional can use to stay current regarding medication errors.

Answer 3

-Evidence-based practice with nationally recognized guidelines
-The Agency for Health Care Quality (AHRQ)
-National Institutes of Health (NIH)
-Epocrates
-Institute for Safe Medication Practices (http://www.ismp.org)
-Confused Drug Name List (http://www.ismp.org/Tools/Confused-Drug-Names.aspx)
-Standard Concentrations for Neonatal Drug Infusions
(https://www.ismp.org/Tools/PediatricConcentrations.pdf)
-Guidelines for Preventing Medication Errors in Children (https://www.ismp.org/newsletters/acutecare/articles/20020601.asp)
-ISMP Updates its List of Drugs with Tall Man Letters
(https://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=1140)

Question 4

Describe the components of a prescription order

Answer 4

-The physician’s name, address and telephone number are required to be
included on prescription drug order
-If the prescription is for a controlled substance, the physician’s DEA number is also required to be
included on the prescription
-Patient’s name and DOB. Also may
include address and weight if child
(× Date Rx is written/issued)
-Legend drugs expire one year after
date issued
-Name of drug and strength
-Avoid trailing zeros—5 mg vs 5.0 mg
[can be mistaken as 50 mg
-Always use leading zeros—0.8 mL vs
.8 mL [can be mistaken for 8 mL]
Directions [Sig.]—with
indication/ route of
administration and frequency—
take by mouth daily for HTN; be
brief but accurate
-Avoid “take as directed” and avoid abbreviations of drugs
-Refills?—write out number [example—zero, not 0]; never leave blank
-Use discretion—acute or chronic disorder
-Mail order?
-Quantity of the drug
-Prescribe only necessary quantity
- Write for specific quantities rather than time period—for example—dispense #30 vs dispense 1 month
-Signature: At a minimum, the title must include RN and the APRN role (need attestation as well for e-signatures signing not good enough)
-Will substitute with generic unless you have write “Brand medically necessary”
-APRN’s name, credentials,
NPI# (CMS rule)
-DEA and DPS for controlled substance RX

Question 5

What is the rule when an error is made when writing a prescription?
(per chat)

Answer 5

1. Do Not Alter or Scribble Over the Error
2. Draw a Single Line Through the Error
3. Make the Correction Clearly
4. Initial and Date the Change
5. Provide an Explanation if Needed
6. If using electronic prescribing systems, void the incorrect prescription and issue a new one.
7. Notify the Pharmacy if Necessary

Question 6

Controlled Substance Regulations

Answer 6

-APRNs may only issue prescriptions for controlled substances in Schedules III through V
-APRNs may only issue a prescription, including a refill of a prescription, for a period that doesn’t exceed 90 days
-Beyond the 90 day period, the APRN must consult with the collaborating physician and document that consult in the patient’s medical record
-Quantity must be written out numerically and as a word
-Expires within 6 months from date of issuance for CIII-V and 21 days for CII
-Cannot be postdated
-No script for children <2 without consultation and documentation
-DEA and DPS of NP and Physician required on scripts

Question 7

When should termination of a patient be considered?

Answer 7

-Non-compliance or non-adherence
-Missed appointments
-Abusive to provider or staff
-Violates Controlled Substance Contract
-Red flags or drug seeking behaviors